Thursday, December 17, 2009

Au Naturel

When I tell someone that I am going to try to deliver our baby naturally, these are the responses I get....look at me with a crazy look and say things like, "Well, good luck" or "Ouch!" or "Sure..." Since I became pregnant I have said that I want to at least try to have our baby without medication, however, I have also always said that I am not going to try to be super woman. I know my limits and if things are unbearable, I am willing to get an epidural. So, in my searches for advice about natural labor and epidurals, I found some interesting information about epidurals....

What’s an epidural?

The anesthesiologist or anesthetist inserts a needle into the epidural space, which lies between the tough, outer membrane that covers the spinal cord and the next deeper membrane. A tiny tube or catheter is threaded through the needle. The needle is removed and the anesthesiologist or anesthetist injects an anesthetic similar to those used in dentistry or, in most hospitals today, a mixture of anesthetic and narcotic (narcotic epidural) into the catheter.
There are two options once the catheter is in:

1. The catheter is attached to a syringe driven by a pump that gradually delivers a continuous dose. This technique is the standard because it provides steady labor pain relief. (Continuous Infusion)
2. The anesthesiologist or anesthetist returns to inject more pain medication into the catheter when the dose wears off. (Intermittent top-ups)

There is also something called a "walking" or "light" epidural. This is when the anesthesiologist or anesthetist may inject narcotic only, a very low dose of anesthetic, or a combination of the two in an attempt to achieve complete mobility with good labor pain relief. These variations are intended to leave some sensation and ability to move the legs. However, many women with such epidurals never walk, even when encouraged to do so. It was hoped that these innovations would achieve equally good labor pain relief while reducing adverse effects, but many women still experience undesired effects.

What are the effects of epidural on pain?
In all but a few women, an epidural can abolish labor pain.

What is involved in having an epidural?
You will be asked to curl up on your side or sit up with your back arched outward. Your back will be washed with antiseptic and covered with a sterile drape. The anesthesiologist or anesthetist will numb the skin before inserting the needle. You must remain absolutely still while the needle is in your back. One or more tests (such as pulling back on the syringe to see if blood flows in) will be performed to make sure the needle is in the right place. A catheter will be threaded through the needle and taped to your back to keep it from moving.

As part of epidural management, you will definitely have:
- an IV (intravenous drip): you will be given about a quart of IV fluid before the epidural is administered
- continuous electronic fetal monitoring (EFM)
- frequent monitoring of blood pressure, usually with an automatic blood pressure cuff that periodically self-inflates and records the results.

You are more likely to require:
- IV Pitocin (oxytocin), a drug to make contractions stronger
- drugs to combat a drop in blood pressure
- a urinary catheter for inability to pass urine
- a vacuum extraction or, less likely these days, a forceps delivery
- Controversy exists over whether you are also more likely to have cesarean section.
- And because you are more likely to have a fever, your baby is more likely to have blood drawn to evaluate for infection and possible treatment with antibiotics.

What are the advantages of an epidural?
- An epidural is the only labor pain relief technique that can completely eliminate pain without narcotics (a plain epidural) doesn't affect consciousness.

What are the drawbacks of an epidural?
- requires the presence of an anesthesiologist or nurse anesthetist: this means an epidural may not be readily available when you want it
- involves delay in obtaining relief: even when the anesthesiologist or anesthetist is in the hospital and not busy elsewhere, it can take an hour from your request to the time when the procedure is done and the medication takes effect
- changes the experience of labor: it converts labor and birth from a normal life experience in which you are an active agent to one in which the equipment (IV, Pitocin pump, epidural pump, electronic fetal monitor, blood pressure cuff, etc.) is the center of attention
- may interfere with your ability to move about: it numbs much, if not all, sensation in the belly, genitals, and legs, and you may feel groggy if it contains narcotics; these effects can prevent you from activities that may help labor progress
- requires or increases the need for other procedures: see the list of procedures, above, that are routinely used or more likely to be used to monitor, prevent, or treat side effects; each of these may introduce its own possible adverse effects
- can cause episodes of low blood pressure: this is a problem because it reduces your baby's oxygen supply
- can cause itching: this is a common, but generally mild, side effect if narcotics are given
may interfere with the pushing phase of labor: you may have difficulty pushing your baby out, and this phase may be lengthened
- can lead to serious tears in your perineum: this is the tissue between your vaginal and anal openings (this is probably due to increased use of vacuum extraction or forceps)
- can cause adverse behavioral effects on the newborn
- can cause newborn jaundice
- can cause life-threatening complications (dangerously low blood pressure, respiratory or cardiac arrest, severe allergic reaction, convulsion): the odds may be as high as 1 in 4,000 to 1 in 3,000 cases.
- can cause maternal fever: the longer you have the epidural, the more likely you are to run a fever, which can have its own consequences: developing a fever appears to increase your likelihood of birth by cesarean section, vacuum extraction, or forceps - fever in the mother may be associated with more babies being born in poor condition and an increase in newborn seizures
because fever raises the possibility of infection, babies of mothers with fever are more likely to be evaluated for infection; this involves drawing blood, and may involve precautionary antibiotics through an IV (intravenous) line; mothers and babies may be separated during these procedures

**First-time mothers tend to have more difficulties with epidural side effects than women who have previously given birth.

Of course, I realize that millions of women have epidurals every day and everything goes that's why I'm not completely against getting one. This is just something I want to try. So, please don't tell me I'm crazy or tell me that I won't be able to do it! ;) Give the pregnant lady some support! haha I may change my mind the moment I go into labor, but that's my right! I've endured 2 years of infertility and 6 months (so far) of a tough pregnancy, so why not torture myself with a few hours of extreme pain? :-)


  1. People always have something to say, don't they! When I told people I was having an epidural, I got rude comments about how I must not care about the baby that much or how I'm being selfish by killing my baby just so I don't feel a little pinch. (Both of which sent my away in tears!) I say, if you've done your research and made an educated decision, good for you! It's your delivery. You are the only one that has to do it all, so you should get to choose what you want! The only time I worry about someone choosing natural birth is when they say they don't like needles or some silly thing like that. But you know what you are doing, so ignore people and do what you want! My epidural went wonderfully. The only bad thing was that I was a little loopy during and after the birth. Not super crazy or anything, but some of the details of when things happened are fuzzy. I remember the important stuff, though, so it wasn't so bad.

  2. Lisa, so true! Everyone has their opinions. :-) But you're right...we are the ones that have to do it, so we get to decide! I'm glad to hear that your epidural went so well...hopefully, if I need one, mine will go as well as yours. Always good to hear about other people's experiences.

  3. If you can do it then go for it! I will be praying for you that you can.

  4. Thanks, I know I'll need all the prayers I can get!! :-)